tbuckley/cabot-search huggingface dataset:
Adherence to NCCN screening guidelines for germline testing of patients with pancreatic cancer at a large academic medical center: A retrospective chart review.
Authors: Claudia Rosso, Naomie Devico Marciano, Deepika Nathan, Wen-Pin Chen, Farshid Dayyani, Jason Zell, Christine E. McLaren, Kathryn Osann, Pamela Flodman, Jennifer Brooke Valerin
Journal: Journal of Clinical Oncology (2022)

342 Background: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis with an overall 5-year survival rate of 10%. Depending on geographic region, 10-20% of cases are hereditary, with mutations in BRCA1 and BRCA2 being the most common. Contrary to popular belief, clinical risk factors such as family history of cancer and young age of onset are not reliable predictors for which patients may carry one of these predisposing mutations. In 2018, the National Comprehensive Cancer Network (NCCN) recommended that all pancreatic cancer patients should receive germline testing, regardless of family history. In a compliance analysis, we hypothesized that patients diagnosed after the NCCN guideline changes were more likely to be referred for genetic testing than those diagnosed beforehand. Methods: We conducted a retrospective chart review to compare trends in genetic testing of PDAC patients diagnosed from 02/17 - 07/18 versus 08/18 - 01/20, pre- and post-changes to NCCN guidelines, respectively.Family and personal cancer history, referral patterns and results of genetic counseling (GC) were recorded. Data were compared using Chi-square, Fisher’s Exact, and multivariate analyses. Results: There were 268 patients treated for PDAC (128 pre-, 140 post-) at a large academic institution. Demographics across both groups were comparable. A total of 175 were seen by our institution’s medical oncologist (84 pre-, 91 post-). Overall, 52 were referred to GC, 32 attended, 12 at our institution. More PDAC patients were referred to GC following the guideline changes (21% vs. 47%, p= 0.0005, Table). Patients with a family history of cancer were more likely to be referred to genetic testing (51% vs. 19%, p = 0.0002). This was the case for both pre- (odds ratio (OR) = 15.217 (95% CI, 2.725, 286.663)) and post- (OR = 3.353, (95% CI 1.263, 9.435)) eras, but the effect was not statistically significant when compared between eras ( p= 0.2034). Of all patients who underwent genetic testing, 27% were found to have a deleterious germline mutation related to hereditary PDAC. Conclusions: Despite a significant increase in referrals of PDAC patients for genetic testing following the guideline changes, adherence remains inconsistent with more than half of patients still not being referred. As a limitation of this study, we were not able to capture if patients were referred for GC outside of our network. Historically, the medical oncologist places the referral. However, as a possible solution to improve guideline adherence, referral for genetic testing could be initiated after initial diagnosis of PDAC by any provider, regardless of their role on the healthcare team.[Table: see text]
Association of race, ethnicity, and socioeconomic characteristics as predictors of cachexia risk and survival in stage IV non–small cell lung cancer (NSCLC).
Authors: Santiago Olaechea, Alison Liu, Brandon Sarver, Christian Alvarez, L Anne Gilmore, Rodney E Infante, Puneeth Iyengar
Journal: Journal of Clinical Oncology (2022)

151 Background: Cachexia, seen in more than a third of patients with non-small cell lung cancer (NSCLC), directly leads to functional and survival detriments. As screening and interventions for cachexia and NSCLC improve, deficits of healthcare access and quality among patients disadvantaged by race and socioeconomic factors must be addressed. Methods: Through retrospective and prospective data collection, we established a cohort of 957 patients diagnosed with stage IV NSCLC between 2014-2020 in Dallas, Texas. Presence of cachexia at diagnosis was determined using consensus criteria for substantial (5% for BMI≥20 and 2% for BMI &lt; 20) unintentional weight loss in the 6 months leading to diagnosis. Analyses including multivariate logistic regression and log-rank testing evaluated for significant associations of variables with cachexia incidence and survival. Results: Black race and Hispanic ethnicity independently associated with more than a 70% increased risk of cachexia at NSCLC diagnosis (Table; P &lt; 0.05). Inclusion of private insurance status as a covariate diminished this finding for Hispanic patients only. Black patients presented at younger ages than White patients (Kruskal-Wallis P =0.0012; T-test P = 0.0002), with an average difference of 3 years. Cachexia at diagnosis was a major predictor of survival, highlighting the importance of addressing differential cachexia risk across race/ethnicity. Conclusions: The elevated cachexia risk observed for Black patients independent of insurance status reveals broader causative factors of disparity. A lack of private insurance may be a primary contributor in Hispanic cachexia prevalence. Targeting these differences could mitigate survival detriments linked to cachexia in minority groups. Supported contributors in broader NSCLC outcome inequities include poor representation in trials substantiating USPSTF guidelines as well as preventable barriers to primary and preventative care. Our interpretation of NSCLC outcome disparity in the context of cachexia demonstrates further consequences of these deficits. Moreover, our findings suggest novel targets for health policy by highlighting the prevalence of undiagnosed unintentional weight loss in minority populations with late-stage NSCLC.[Table: see text]
Real-world treatment (tx) patterns, cost, and overall survival (OS) by line of therapy among patients (pt) with mantle cell lymphoma (MCL): A SEER-Medicare (SM) analysis.
Authors: Scott J. Keating, Sanika Rege, Ali McBride, Ruchit Shah, Joyce Qian, Viktor Chirikov
Journal: Journal of Clinical Oncology (2022)

19 Background: MCL is an aggressive form of non-Hodgkin’s lymphoma with an incidence of 1 in 200,000 in the United States. Limited evidence exists on real-world tx utilization, costs, and survival outcomes associated with MCL among older pts in the US. This study examined tx patterns and quantified cost and OS in first- (1L), second- (2L), and third-line (3L) settings in SM pts with MCL. Methods: This retrospective cohort study included older pts (age ≥ 66 yrs) with MCL, identified using a SM-linked database from 01/01/2013 to 12/31/2017, and followed for 2 yrs. Pts were eligible if they had ≥ 1L MCL tx with ≥ 6 months (mo) of continuous enrollment before and after MCL diagnosis. Pts with other primary malignancies or stem cell transplantation (SCT) ≤ 6 mo before first diagnosis of MCL were excluded. A tx regimen was defined as combination of all agents ≤ 35 days of tx initiation; rituximab (R) monotherapy initiated ≤ 7 mo after R-containing regimen was considered maintenance. For each tx line, all-cause and MCL-specific health care resource utilization (HCRU) and costs were calculated per pt per year (PPPY) and adjusted to 2021 US dollars. Kaplan‒Meier method for survival analysis was used to estimate OS in 1L, 2L, and 3L settings. Results: This study included 559 pts with newly diagnosed MCL: median (range) age, 75 (66‒94) yrs; male, 59.7%; mean Charlson Comorbidity Index, 1.44; stage IV (45.3%), and poor performance status (12.2%); subsequently, 305 (54.6%) received 2L and 153 (27.4%) received 3L tx. The most common regimens were bendamustine + R (51.7%) in 1L and ibrutinib in 2L (17%) and 3L (15.7%). For 1L, 2L, and 3L, 6.3%, 14.8%, and 8.5% of pts received radiation therapy, and 0.4%, 5.1%, and 8.6% received SCT, respectively. Median time to next treatment from start of previous line was 245, 127, and 222 days for 1L to 2L, 2L to 3L, and 3L to 4L, respectively. Mean (SD) all-cause total (medical + drug) costs were $169,210 ($174,904), $209,092 ($254,229), and $185,718 ($220,495) PPPY. The median OS from MCL diagnosis until end of follow-up was 47.2 mo (95% CI, 40.9‒53.7). The 12-mo survival was 81.1% (95% CI, 77.5%‒84.9%), 71.4% (95% CI, 65.5%‒77.9%), and 69.9% (95% CI, 61.8%‒79.1%) for 1L, 2L, and 3L, respectively. Conclusions: The study results report substantial costs associated with the use of standard care therapies among older pts with MCL. New treatments are needed to improve clinical outcomes, and reduce HCRU and overall healthcare costs in MCL.
Time to diagnosis and treatment initiation during the COVID-19 pandemic among rural patients with cancer.
Authors: Izumi Okado, Michelle Liu-Duerr, Carry Elhajj, Randall F. Holcombe
Journal: Journal of Clinical Oncology (2022)

132 Background: Time to diagnosis (TTD) and treatment initiation (TTI) are important measures of access and quality of cancer care, but little is known about TTD and TTI for rural cancer patients. Rural residents experience disproportionate burdens of cancer including higher incidence and mortality, and many rural patients face challenges in health care access. Further understanding of TTD and TTI in rural areas is essential to improving the quality of cancer care delivery and cancer outcomes in rural areas. In this study, we describe TTD and TTI among rural cancer patients in Hawaii during the COVID-19 pandemic. Methods: Information about TTD and TTI was collected from 80 rural cancer patients enrolled on a care coordination study between Sept. 2020 and Dec. 2021. Participants were receiving active treatment for any cancer and residing in rural areas in Hawaii. We used descriptive statistics to describe TTD and TTI for the overall sample and specifically for those with breast and GI cancers, the two most common cancers in this study sample. Results: Participants were 56% female, with the mean age of 63 (SD = 12.1). 43% were White/Caucasian, 30% Native Hawaiian, and 25% two or more race. Reporting of symptoms to a healthcare provider led to diagnosis for 61.6% of the overall sample, whereas 38.4% received diagnosis following screening. For breast cancer, 36.8% indicated symptoms led to diagnosis, and 63.2% by screening. Among those with GI cancer, 76.5% reported symptoms led to diagnosis, and 23.5% by screening. Overall, 62.5% of participants reported TTD of within one month (&lt; = 30 days) of screening or reporting symptoms to a healthcare provider (30-day TTD 62.5% for breast and 60.0% for GI). Median TTI for the overall sample was 60.6 days (IQR 30-62). For those with breast and GI cancers, median TTI was 61.0 (IQR 31-70) and 31.0 (IQR 0-61) days, respectively. Conclusions: Our results demonstrate that although TTD in this rural sample was comparable to other studies, TTI overall, and particularly for those with breast cancer, was nearly twice the TTI reported in other population-based studies. Delays in cancer treatment initiation have been associated with worse survival for breast and other cancers, especially among underserved populations. Our findings indicate that during the COVID-19 pandemic, rural residents in Hawaii experienced substantial delays in cancer treatment initiation. This study highlights the importance of addressing timely healthcare system access to minimize delays in treatment initiation and to improve health outcomes for rural cancer patients.
Associations of employment disruptions and financial hardship among individuals diagnosed with cancer in the United States.
Authors: Michael T. Halpern, Janet De Moor, Xuesong Han, Jingxuan Zhao, Zhiyuan Zheng, K. Robin Robin Yabroff
Journal: Journal of Clinical Oncology (2022)

47 Background: Financial hardship is experienced by approximately half of working-age individuals diagnosed with cancer. Many working individuals diagnosed with cancer also experience disruptions with their employment. This study examines whether employment disruptions are associated with financial hardship among individuals diagnosed with cancer in the US. Methods: We utilized data from the 2016/2017 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer self-administered questionnaires and identified individuals diagnosed with cancer at age &gt;18 who worked for pay at the time of or following their cancer diagnosis. Employment disruption was defined as taking extended paid time off work; switching to a part time or less demanding job or to a flexible work schedule; and/or retiring early due to cancer, cancer treatment, or late effects. Financial hardship was defined in 3 domains: material (borrowing money, financial sacrifices, or being unable to cover medical costs); psychological (worrying about medical bills, financial stability, keeping job/income, or future earnings); and behavioral (delaying/forgoing medical care because of cost). Multivariable logistic regression analyses adjusting for the MEPS survey design were used to determine associations of employment disruption due to cancer with any financial hardship and with financial hardship intensity while controlling for patient demographic, health insurance, and clinical characteristics. Results: Among 732 individuals with a cancer history, 47.4% experienced employment disruptions and 55.9% experienced any financial hardship. Financial hardship was significantly more common among cancer survivors with employment disruption than without disruptions (68.7% vs. 44.5%; p-value of difference &lt; 0.0001). Findings were consistent across multiple hardship measures and domains. Cancer survivors with employment disruptions were more likely to have greater (OR = 2.8; 95% CI 2.0, 3.9) financial hardship intensity. Individuals of race/ethnicity other than non-Hispanic White were also more likely to experience financial hardship while older individuals, women, and those with college education or who were married were less likely to experience financial hardship. Conclusions: Employment disruptions are common and significantly associated with multiple types of financial hardship among cancer survivors. Employer workplace accommodation and other policies to minimize disruptions among individuals diagnosed with cancer may reduce financial hardship in this vulnerable population.
Racial/ethnic differences in telemedicine utilization and satisfaction among patients with breast cancer during the COVID-19 pandemic.
Authors: Jincong Freeman, Fangyuan Zhao, Rita Nanda, Olufunmilayo I. Olopade, Dezheng Huo
Journal: Journal of Clinical Oncology (2022)

384 Background: Telemedicine utilization has increased in recent years, with widespread adoption during the COVID-19 pandemic. Literature has documented benefits of telemedicine in cancer care and symptom management; patients (pts) report satisfaction with telemedicine. Data on telemedicine utilization is lacking, and racial/ethnic differences in utilization and satisfaction are unknown among breast cancer pts. Methods: Two surveys, conducted in 2020 and 2021, collected data on telemedicine utilization and satisfaction among breast cancer pts enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Telemedicine utilization (e.g., telephone call or video conference) during the COVID-19 pandemic was per self-report. Satisfaction was assessed using a 5-point Likert scale. Mixed-effects (ME) binary logistic regression was used to model utilization, and ME proportional odds regression was used to model satisfaction. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Results: Of 1,260 respondents in 2020, 57.6% were ages 40-65, 72.2% were White, 22.3% were Black, 75.1% had private insurance, and 99% had early-stage breast cancer. Of 1,299 respondents in 2021, 58.6% were ages 40-65, 71.4% were White, 21.9% were Black, 77.6% had private insurance, and 98.9% had early-stage breast cancer. In 2020, 59.1% reported using telemedicine, while in 2021, 64.9% did. Black pts were most likely to have used telemedicine, followed by Asian, Hispanic, and White pts. In the adjusted ME models, Black pts were more likely than White pts to have used telemedicine (AOR 2.9, 95% CI: 1.6-5.4), while no differences in utilization were observed between Asian and White (AOR 2.1, 95% CI: 0.6-7.4) or Hispanic and White (AOR 1.7, 95% CI: 0.5-6.3) pts over time. In 2020, 90.3% reported somewhat to extreme satisfaction with telemedicine, and in 2021, 91.2% did. There were no racial/ethnic differences in satisfaction between Black and White (AOR 1.1, 95% CI: 0.7-1.7), Asian and White (AOR 0.4, 95% CI: 0.2-1.1), or Hispanic and White (AOR 0.5, 95% CI: 0.2-1.4) pts over time. Conclusions: In this multiethnic cohort of breast cancer pts, telemedicine utilization and satisfaction were high over time and across racial/ethnic groups. Furthermore, racial/ethnic minorities were more likely to have used telemedicine. Our findings suggest an important role for telemedicine in reducing barriers to care and promoting health equity in breast cancer pts.
Leveraging continuing education and implementation science approaches to improve the care of patients with myeloproliferative neoplasms.
Authors: Joseph Kim, Ruben A. Mesa, Cody Carter, Anthony Loc Nguyen, Eric Lau, Parthiv Sheth, Suhani Dalal, Rajesh Behl, Pablo Gutman, Linda Gracie-King, Marc David Viens, Victor Ocana
Journal: Journal of Clinical Oncology (2022)

334 Background: Myeloproliferative neoplasms (MPN) represent a heterogenous group of disorders associated with complicated symptom profiles and a propensity for disease transformation that may portend poor prognosis. Clinicians treating patients with MPN may improve treatment planning, disease monitoring, and care coordination by ensuring they check for driver mutations, assess and document symptoms, and evaluate prognostic factors. MPN is relatively uncommon, so clinicians may forget to apply these practices. Blending continuing education with implementation science approaches may help clinicians provide consistent, high-quality care for patients with MPN. This project was supported by an educational grant from Bristol Myers Squibb. Methods: Three hospital-based cancer centers participated in this 18-month longitudinal, multiphase CME/CE and QI initiative. Each hospital performed a baseline assessment by reviewing how their clinicians diagnosed and treated MPN. This process involved chart reviews (N = 38), focus group discussions, and online surveys. Clinicians also participated in two CE interventions and identified ways to implement practice changes that would lead to better care. Each hospital developed improvement projects that addressed one or more of the following: molecular diagnostics, symptom assessment and documentation, prognostic scoring, and treatment selection/planning. Clinicians assessed the feasibility of ideas such as reflex testing protocols, scheduled audit/feedback, patient registries, and clinical documentation shortcuts (eg, SmartText/Phrases).Results: As a result of the CE activities combined with the QI projects, the following competency-based educational outcomes were observed among clinicians: 40% increase (29.6% to 70%) regarding prognostic risk stratification; 41% increase (25.9% to 66.7%) in personalizing treatment plans based on disease-/patient-specific factors; and 24% increase (47.4% to 71.4%) in prioritizing goals of treatment. Based on patient chart data, the QI projects resulted in 15.8% increase (84.2% to 100%) in patients with MPN receiving molecular testing (eg, JAK2, CALR, and MPL genes); 66.7% increase (0% to 66.7%) in patients with MPN who have a documented symptom burden score based on a validated tool (eg, MPN-10); 24.1% increase (34.2% to 58.3%) in patients with MPN who have a documented prognostic score (eg, DIPSS); and 38.8% increase (22.7% to 61.5%) in eligible patients with MPN who are treated with JAK inhibitors. Conclusions: This project demonstrates how multiphase education and QI methods can help clinicians improve care for patients with MPN. Implementation strategies that triggered appropriate reminders and facilitated clinical documentation were considered most useful and sustainable for routine clinical practice.
Implementing process improvements to enhance distress screening and management.
Authors: Nicole Lynn Stout, Crystal Street, Patricia Policicchio, Joe Summers, Adrienne Duckworth
Journal: Journal of Clinical Oncology (2022)

352 Background: While distress is prevalent among individuals living with cancer, distress management has not been optimized across cancer care delivery despite standards for screening. This manuscript describes the development of an enhanced Distress Thermometer(eDT) and shares the process for implementing the (eDT) across a cancer institute by highlighting process changes and improvements at the provider, system, and clinic levels. Methods: Focus groups and surveys were used at the provider-level to outline the problem space and to identify solutions to improve distress screening and management. Through stakeholder engagement, an eDT was developed and rolled out across the cancer institute. The eDT included pull down menus for each of the DT problem areas to provide detailed context of the specific issue. EHR infrastructure changes were implemented at the system-level to improve the use of the distress screening findings and generate automated referrals for specialty services. Clinic-level workflows were adapted to improve screening and distress management using the eDT. Patient-level data was collected to examine severity of distress and referral pathway utilization comparisons between original DT and eDT. Results: Stakeholder focus group participants (n = 17) and survey respondents (n = 13) found the eDT to be feasible and acceptable for distress identification and management. System-level technical EHR changes resulted in high accuracy with patient identification for distress management and 100% of patients with moderate to severe distress were connected directly to an appropriate specialty provider. Clinic-level workflow changes to expand eDT use improved compliance rates with distress screening from 86% to 98% over a 1 year period. We are currently analyzing utilization data based on distress screening at the patient level and will provide these results in the final presentation. Conclusions: An eDT that provides more context to patient-reported problems improved identification of referral pathways for patients experiencing moderate to high distress during cancer treatment and enhanced overall clinical use of the eDT. Combining process improvement interventions across multiple levels in the cancer care delivery system enhanced the success of this project. These processes and tools could support improved distress screening and management across cancer care delivery settings.